Multidisciplinary work-up of a patient with transthyretin amyloid cardiomyopathy

(A1-A3) Typical 4-chamber echocardiographic view (A1) and strain pattern (A2 and A3) characteristic of an infiltrative process.
(B1-B4) 4-chamber, steady-state, free-precession image (B1) corresponding to a 4-chamber native T1 map (B2). The corresponding LGE image (B3) shows transmural LGE, and the corresponding ECV map (B4) shows high values.
(C1-C2) Bone tracer cardiac scan (whole-body anterior ^99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid scintigraphy) image (C1) and single-photon emission CT image (C2) show Perugini grade 2 abnormal cardiac uptake.